If a child over the age of 4 has been toilet trained and then passes stool and soils clothes again, this is called encopresis. The child may or may not be doing this on purpose.
Soiling; Incontinence - stool
The child usually has constipation. The stool is hard, dry, and stuck in the colon (called fecal impaction). The child then passes only wet or almost liquid stool that flows around the hard stool. It may leak out during the day or night.
Other causes may include:
- Not toilet training the child
- Starting toilet training when the child was too young
- Emotional problems, like oppositional defiant disorder
- Conduct disorder
Whatever the cause, the child may feel shame, guilt, or low self-esteem, and may hide signs of encopresis.
Factors that may increase the risk of encopresis:
- Being male
- Chronic constipation
- Low socioeconomic status
Symptoms can include any of the following:
- Being unable to hold stool before getting to a toilet (bowel incontinence)
- Passing stool in inappropriate places (as in the child's clothes)
- Keeping bowel movements a secret
- Having constipation and hard stools
- Sometimes passing a very large stool that almost blocks the toilet
Exams and Tests
The doctor may feel the stool stuck in the child’s rectum (fecal impaction). An x-ray of the child’s belly may show impacted stool in the colon.
The goal is to:
- Prevent constipation
- Keep good bowel habits
It is best for parents to support, rather than criticize or discourage the child.
Treatments may include any of the following:
- Giving the child laxatives or enemas to remove dry, hard stool.
- Giving the child stool softeners.
- Having the child eat a diet high in fiber (fruits, vegetables, whole grains) and drink plenty of fluids to keep the stools soft and comfortable.
- Taking flavored mineral oil for a short period of time. This is only a short-term treatment because mineral oil interferes with the absorption of calcium and vitamin D.
- Seeing a pediatric gastroenterologist when these treatments aren't enough. The doctor may use biofeedback, or teach the parents and child how to manage encopresis.
- Seeing a psychotherapist to help the child deal with associated shame, guilt, or loss of self-esteem.
For encopresis without constipation, the child may need a psychiatric evaluation to find the cause.
Most children respond to treatment.
- If encopresis is not treated, the child may have low self-esteem and problems making and keeping friends.
- If encopresis is not corrected, the child may develop chronic constipation.
When to Contact a Medical Professional
Call for an appointment with your health care provider if a child is over 4 years old and has encopresis.
Toilet train in a positive way when the child is the right age.
If your child shows signs of constipation, such as dry, hard, or infrequent stools, ask your doctor how to treat it.
Har AF, Croffie JM. Encopresis. Pediatr Rev. 2010;31:368-374.
Katz ER, DeMaso DR. Encopresis. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 21.4.